The Scotsman’s monthly review of a book about health, promoted by Wellcome
“The feeling passes quickly but it leaves an ache, and for a while everything that follows is filtered through it.” This is a description, from Sam Guglani’s affecting novel, Histories, of the moment a nurse sees a person rather than a patient, the emotional jolt denting hard-won defences. But it may as well be a description of the novel itself. There is something meditative about Guglani’s spare, poetic prose. And unsettling too. It stays with you long after the book is finished.
It may be slight, just 130 pages or so, but this is a novel with serious emotional heft. There are 18 chapters, each told from the point of view of a different person – the consultant physician, the junior doctor, the oncologist, the chaplain, the medical student, the nurse, the patient – and these are knitted together by place, an oncology ward in a hospital, and time, a single week in October.
Guglani manipulates his form expertly, shifting between first person narrative, to dialogue between colleagues, to dictated dictaphone entries, interweaving characters in a way that’s only fully revealed in second or third readings. Structurally, this allows us an insight into how a hospital is itself a kind of microcosm, an organism given life by the coming together of disparate individuals working, however chaoticially, together. Thematically, it provides a multi-dimensional exploration of power and empathy, hope, loss, belonging and the challenge of genuine communication. “Meaningful contact is so elusive, even here in a hospital” reflects Emily, a consultant oncologist fearing burnout, her feelings for her patients “like a valve switching off”.
There is a growing genre of books written by doctors about their profession – I’ve reviewed more than one of them in these pages – but Guglani’s subject isn’t the particularities of a medical procedure or the political plight of our underfunded, overstretched health service, or even the emotional consequences of a job that places enormous demands on those who do it. That’s not to say that these issues aren’t present, but rather that Guglani foregrounds matters of a different magnitude, matters one might regard as even more profound. His subject is his characters’ humanity, as it’s tested and shaped in airless consulting rooms and in wards behind poorly drawn curtains. These characters are scrutinised by an unsparing eye, their frailties and feelings probed with forensic, microscopic precision.
A consultant clinical oncologist in Cheltenham, Guglani has a masters in creative writing from Oxford, writes a column in the Lancet, and is a founder of Medicine Unboxed, an organisation that promotes an understanding of medicine through the arts and humanities. It’s the poeticism of his prose that renders this novel so poignant and evocative. The titular histories emerge, not chronologically, not neatly, but as they would in life: disordered, fragmented, partial. “I collect them around here, histories, hundreds of them,” says the porter, Josh Webster. “Moving people along corridors, talking cheek to cheek or with my head above them. No eye contact, just our voices mingling in the air. That way, you stumble on the story rather than taking it, like happening on it by accident, caught as it honestly is.” This is how Guglani has written his novel and is, in part, why it rewards repeat readings – each time something that we didn’t have adequate information to understand at a first attempt is revealed; characters whose fates are played out late in the novel make cameo appearances in the early chapters and connections become apparent.
In a sense this novel is an examination of communication – what we can make known, even to ourselves. “How to speak and listen to people. The history-taking”, is how the lowly porter describes it. And his view of the medics with whom he works is critical. “Passing them sometimes, I catch the things they say to patients and I’m amazed they get any history at all. Asking what they ask in that way they do. Difficult things, huge things, all the time looking people straight in the eyes.”
Guglani is unsparing in his exposure of the flaws and limitations of the doctors and yet he imbues them with such humanity, our own criticism is tempered. Pomposity, emotional shutdown, crippling self-doubt, swagger – each a coping mechanism, an attempt to bear the enormity of the expectations of those who rely on them, at least in some instances, for nothing short of life itself.
If there’s a weak spot, for me it’s the stories in the collection about characters who would most likely be working class, the hospital cleaner, the porter, a hairdresser patient. The writing remains polished but the voice is less convincing. This isn’t the case with the medics, whether it’s James Chester, the consultant oncologist himself diagnosed with cancer, or Seb, a junior doctor wracked with inadequacy: “It was all perfect snow before he started, the idea of him, of medicine... the idea of him as a doctor. Now there are footprints all over it, mud and slush thrown up. He doesn’t know who to be, how to be.”
Those are the questions Guglani poses for each of his characters and his exploration is as moving as it is illuminating.
*Histories, by Sam Guglani, Riverrun, 128pp, £12.99